{
"Npi": {
"NPI": "1114161825",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "THE YOUTH SUCCESS NETWORK",
"ParentOrgTIN": null,
"OrgName": "THE YOUTH SUCCESS NETWORK - COMMUNILINK AND MHO",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "16 WEST MAIN ST",
"SecondLineMailingAddress": "FLOOR 2",
"MailingAddressCityName": "FREEHOLD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07728",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-897-6465",
"MailingAddressFaxNumber": "877-438-8976",
"FirstLinePracticeLocationAddress": "16 W MAIN ST",
"SecondLinePracticeLocationAddress": "FLOOR 2",
"PracticeLocationAddressCityName": "FREEHOLD",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07728-2210",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "888-897-6465",
"PracticeLocationAddressFaxNumber": "877-438-8976",
"EnumerationDate": "04/24/2009",
"LastUpdateDate": "04/24/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRAY",
"AuthorizedOfficialFirstName": "M",
"AuthorizedOfficialMiddleName": "WELLESLEY",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "888-897-6465",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "385HR2055X",
"TaxonomyName": "Child Mental Illness Respite Care",
"LicenseNumber": "PENDING",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "64669006",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}